1
|
Bidart JPM, Rosa RG, Bessel M, Pedrotti LG, Goldani LZ. Mortality predictors in patients with suspected sepsis in the emergency department of a tertiary care hospital: a retrospective cohort study. Int J Emerg Med 2024; 17:74. [PMID: 38880894 PMCID: PMC11181565 DOI: 10.1186/s12245-024-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Sepsis remains a worldwide major cause of hospitalization, mortality, and morbidity. To enhance the identification of patients with suspected sepsis at high risk of mortality and adverse outcomes in the emergency department (ED), the use of mortality predictors is relevant. This study aims to establish whether quick sofa (qSOFA) and the severity criteria applied in patients with suspicion of sepsis in a monitored ED are in fact predictors of mortality. METHODS We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study. RESULTS The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality. CONCLUSIONS Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED's initial care.
Collapse
Affiliation(s)
- João P M Bidart
- Emergency Department, Moinhos de Vento Hospital, 910, Ramiro Barcelos Street, Porto Alegre, Zip code, 90035-001, Brazil.
| | - Regis G Rosa
- Internal Medicine Department, Moinhos de Vento Hospital, Ramiro Barcelos, 630, Porto Alegre, 90035- 001, Brazil
| | - Marina Bessel
- Proadi Social Responsability, Moinhos de Vento Hospital, Ramiro Barcelos, 910, Porto Alegre, 90035- 000, Brazil
| | - Luana G Pedrotti
- Proadi Social Responsability, Moinhos de Vento Hospital, Ramiro Barcelos, 910, Porto Alegre, 90035- 000, Brazil
| | - Luciano Z Goldani
- ⁵Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, 90035-003, Brazil
| |
Collapse
|
2
|
De Silva M, Chadwick W, Naidoo N. Screening tools for sepsis identification in paramedicine and other emergency contexts: a rapid systematic review. Scand J Trauma Resusc Emerg Med 2023; 31:74. [PMID: 37946312 PMCID: PMC10634129 DOI: 10.1186/s13049-023-01111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/14/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening condition that contributes significantly to protracted hospitalisations globally. The unique positioning of paramedics and other emergency care cadres in emergency contexts enable the prospect of early identification and management of sepsis, however, a standardised screening tool still does not exist in the emergency setting. The objective of this review was to identify and recommend the most clinically ideal sepsis screening tool for emergency contexts such as emergency departments and out-of-hospital emergency contexts. METHODS A rapid review of five databases (Medline, Embase, the Cochrane Library, CINAHL, and ProQuest Central) was undertaken, with searches performed on February 10, 2022. Covidence software was used by two authors for initial screening, and full text review was undertaken independently by each reviewer, with conflicts resolved by consensus-finding and a mediator. Systematic reviews, meta-analyses, randomised controlled trials, and prospective observational studies were eligible for inclusion. Data extraction used an a priori template and focused on sensitivity and specificity, with ROBINS-I and ROBIS bias assessment tools employed to assess risk of bias in included studies. Study details and key findings were summarised in tables. The a priori review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/3XQ5T ). RESULTS The literature search identified 362 results. After review, 18 studies met the inclusion criteria and were included for analysis. There were five systematic reviews, with three including meta-analysis, eleven prospective observational studies, one randomised controlled trial, and one validation study. CONCLUSIONS The review recognised that a paucity of evidence exists surrounding standardised sepsis screening tools in the emergency context. The use of a sepsis screening tool in the emergency environment may be prudent, however there is currently insufficient evidence to recommend a single screening tool for this context. A combination of the qSOFA and SIRS may be employed to avoid 'practice paralysis' in the interim. The authors acknowledge the inherent potential for publication and selection bias within the review due to the inclusion criteria.
Collapse
Affiliation(s)
- Megan De Silva
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia
| | - William Chadwick
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia
| | - Navindhra Naidoo
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia.
| |
Collapse
|
3
|
Lai Q, Xia Y, Yang W, Zhou Y. Development and Validation of a Rapid and Efficient Prognostic Scoring System for Sepsis Based on Oxygenation Index, Lactate and Glasgow Coma Scale. J Inflamm Res 2023; 16:2955-2966. [PMID: 37484996 PMCID: PMC10362864 DOI: 10.2147/jir.s418531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To develop a concise scoring system for efficient and rapid assessment of sepsis prognosis applicable to emergency departments. Methods This was a single-center retrospective cohort study of patients with sepsis. In this study, a new scoring system (oxygenation index, lactate, and Glasgow coma scale: GOL) was developed through a derivation group, and then the GOL was validated using a validation group. Multivariate logistic regression analysis was performed to investigate the relationship between GOL and 28-day adverse outcomes. The GOL was compared with the previous scoring system using receiver operating characteristic curves (ROC) and decision analysis curves. The endpoints of this study were mortality, mechanical ventilation (MV), and admission to the intensive care unit (AICU). Results 608 patients were included in the derivation group and 213 patients in the validation group, with 131 and 42 deaths, respectively. In the validation group, lactate (Lac), oxygenation index (PaO2/FiO2), and Glasgow coma scale score (GCS), the three best performers in predicting 28-day mortality from receiver operating characteristic curves, were used to construct the GOL. The higher the GOL score, the higher the incidence of death, MV and AICU within 28 days. Multifactorial logistic regression analysis showed that when the GOL was greater than 1, it was an independent risk factor for 28-day mortality, MV, and AICU. In predicting 28-day mortality, GOL was superior to the quick Sequential Organ Failure Assessment (qSOFA), Mortality in Emergency Department Sepsis Score (MEDS), Systemic Inflammatory Response Syndrome Score (SIRS), and Modified Early Warning Score (MEWS), and was comparable to the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA). Conclusion The GOL is a simple, rapid, and accurate method for early identification of patients at increased risk of in-hospital death from sepsis.
Collapse
Affiliation(s)
- Qiang Lai
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yiqin Xia
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Wentao Yang
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yiwu Zhou
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| |
Collapse
|
4
|
Qiu X, Lei YP, Zhou RX. SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2023; 21:891-900. [PMID: 37450490 DOI: 10.1080/14787210.2023.2237192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. METHODS Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. RESULTS Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). CONCLUSIONS NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.
Collapse
Affiliation(s)
- Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu-Peng Lei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui-Xi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
5
|
Svendsen M, Steindal SA, Hamilton Larsen M, Trygg Solberg M. Comparison of the systematic Inflammatory response syndrome and the quick sequential organ failure assessment for prognostic accuracy in detecting sepsis in the emergency department: A systematic review. Int Emerg Nurs 2023; 66:101242. [PMID: 36571931 DOI: 10.1016/j.ienj.2022.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Awareness and prompt recognition of sepsis are essential for nurses working in the emergency department (ED), enabling them to make an initial assessment of patients and then to sort them according to their condition s severity. The aim of this systematic review was to investigate prognostic accuracy in detecting sepsis in the emergency department by comparing the previous sepsis-2 screening tool, the Systemic Inflammatory Response Syndrome (SIRS) and the current sepsis-3 screening tool, the Quick Sequential Organ Failure Assessment (qSOFA). METHODS This systematic review used the guideline by Bettany-Saltikov and McSherry and was reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) 2020 checklist. The protocol was registered in PROSPERO. A systematic search was conducted using the CINAHL, EMBASE and MEDLINE databases. Study selection and risk of bias was performed independently by pair of authors. RESULTS Five articles were included. Overall, SIRS showed higher sensitivity than qSOFA, while qSOFA showed higher specificity than SIRS. The positive predictive value for qSOFA was superior, while there was a minor deviation in negative predictive value between qSOFA and SIRS. CONCLUSION The overall recommendation based on the included studies indicates that qSOFA is the better-suited screening tool for prognostic accuracy in detecting sepsis in the emergency department.
Collapse
Affiliation(s)
- Marius Svendsen
- Lovisenberg Diaconal University College, Department for postgraduate studies, Oslo, Norway; Emergency Medicine section Bærum Hospital, Norway.
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Department for postgraduate studies, Oslo, Norway
| | - Marie Hamilton Larsen
- Lovisenberg Diaconal University College, Department for postgraduate studies, Oslo, Norway
| | - Marianne Trygg Solberg
- Intensive Care Nurse Specialist, Master of Nursing Sci., PhD. Lovisenberg Diaconal University College, Department for postgraduate studies, Oslo, Norway
| |
Collapse
|
6
|
Casalboni S, Valli G, Terlizzi F, Mastracchi M, Fidelio G, De Marco F, Bernardi C, Chieruzzi A, Curcio A, De Cicco F, Colella N, Papasidero ID, Tartarone E, Ruggieri MP, Di Somma S. 30 Days Mortality Prognostic Value of POCT Bio-Adrenomedullin and Proenkephalin in Patients with Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121786. [PMID: 36556987 PMCID: PMC9783595 DOI: 10.3390/medicina58121786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
Background and Objective: Sepsis is a worldwide severe disease with a high incidence and mortality rate. Sepsis is a frequent cause of admission to the emergency department (ED). Although prognostic scores (Sequential Organ Failure Assessment, SOFA; New Early Warning Score, NEWS; Rapid Emergency Medicine Score, REMS) are commonly used for risk stratification in septic patients, many of these scores are of poor utility in the ED. In this setting, biomarkers are promising alternatives, easier to perform and potentially more specific. Bio-adrenomedullin (Bio-ADM) and Proenkephalin (PenKid) seem to have a key role in the development of organ dysfunctions induced by sepsis and, therefore, could help in the risk stratification of patients with sepsis at ED admission. The aim of this study was to evaluate the utility of Bio-ADM and PenKid, obtained through a point of care (POCT) device, in predicting 30 days mortality for patients presenting to the ED with sepsis. Methods and Results: In total, 177 consecutive adult patients with a diagnosis of sepsis presenting to the ED of San Giovanni Addolorata Hospital in Rome, Italy, between May 2021 and April 2022 were enrolled in this prospective observational study. For each patient, Bio-ADM and PenKid were obtained at ED admission together with SOFA, NEWS and REMS scores. Next, 30 days follow-up data were collected to evaluate patient mortality. Both biomarkers (Bio-ADM and PenKid) and clinical scores (SOFA, NEWS and REMS) were good predictors of mortality at 30 days, with Bio-ADM and REMS outperforming the others. Moreover, PenKid resulted in being linked with the worsening of kidney function. Conclusions: In patients presenting with sepsis in the ED, Bio-ADM and PenKid, evaluated with a POCT device, predicted 30-day mortality. These two biomarkers seem even more useful when integrated with clinical risk scores at ED admission.
Collapse
Affiliation(s)
- Silvia Casalboni
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Gabriele Valli
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Ferdinando Terlizzi
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Marina Mastracchi
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Giacomo Fidelio
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Francesca De Marco
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Caterina Bernardi
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Anastasia Chieruzzi
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessia Curcio
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco De Cicco
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Colella
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Ilaria Dafne Papasidero
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Emanuele Tartarone
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Pia Ruggieri
- Department of Emergency Medicine, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Salvatore Di Somma
- Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy
- GREAT Network (Global Research on Acute Condition Team), 00100 Rome, Italy
- Department of Medical -Surgery Sciences and Translational Medicine, Sapienza University of Rome, 00184 Rome, Italy
- Correspondence:
| |
Collapse
|
7
|
Prognostic Accuracy of qSOFA and SIRS for Mortality in the Emergency Department: A Meta-Analysis and Systematic Review of Prospective Studies. Emerg Med Int 2022; 2022:1802707. [PMID: 35572161 PMCID: PMC9098353 DOI: 10.1155/2022/1802707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This meta-analysis aimed to determine the prognostic performance of quick sequential organ failure assessment (qSOFA) score in comparison to systemic inflammatory response syndrome (SIRS) in predicting in-hospital mortality in the emergency department (ED) patients. Methods Eligible studies comparing the performance of qSOFA and SIRS in predicting in-hospital death of ED patients were identified from searching PubMed, Embase, and Cochrane. Raw data were collected, and the pooled sensitivity and specificity were calculated for qSOFA and SIRS. The summary receiver operating curve was also plotted to calculate the area under the curve. Results A total of 16 prospective studies with 35,756 patients and 2,285 deaths were included. The pooled sensitivity was 0.43 (95% CI: 0.32–0.54) and 0.8 (95% CI: 0.73–0.86) for qSOFA and SIRS, respectively. The pooled specificity was 0.89 (95% CI: 0.84–0.93) and 0.39 (95% CI: 0.3–0.5) for qSOFA and SIRS, respectively. The area under the summary receiver operating curve was 0.76 (95% CI: 0.72–0.8) and 0.67 (95% CI: 0.62–0.72) for qSOFA and SIRS, respectively. A significant heterogeneity was observed for both qSOFA and SIRS studies. Conclusion The present meta-analysis suggested that qSOFA had a higher specificity but a lower sensitivity as compared with SIRS in predicting in-hospital mortality in the ED patients. qSOFA appeared to be a more concise and simple way to recognize patients at high risk for death. However, the use of SIRS in the ED cannot be completely replaced since the sensitivity of qSOFA was relatively lower.
Collapse
|
8
|
Gavelli F, Castello LM, Avanzi GC. Management of sepsis and septic shock in the emergency department. Intern Emerg Med 2021; 16:1649-1661. [PMID: 33890208 PMCID: PMC8354945 DOI: 10.1007/s11739-021-02735-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
Early management of sepsis and septic shock is crucial for patients' prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.
Collapse
Affiliation(s)
- Francesco Gavelli
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, Novara, Italy.
- Emergency Medicine Department, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy.
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, Novara, Italy
- Emergency Medicine Department, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Via Solaroli 17, Novara, Italy
- Emergency Medicine Department, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| |
Collapse
|
9
|
[Disorientation and delirium assessment : A secondary analysis of a prospective, observational study]. Med Klin Intensivmed Notfmed 2021; 117:419-427. [PMID: 34432084 PMCID: PMC9452438 DOI: 10.1007/s00063-021-00850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/08/2021] [Accepted: 07/03/2021] [Indexed: 10/25/2022]
Abstract
Disorientation may present as a warning sign of developing delirium. The most commonly used delirium assessment tool in Germany, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), does not rate "disorientation", since intubated patients cannot communicate verbally. However, the majority of German ICU patients are not orally intubated, so they could be examined for their orientation. This study was carried out to investigate whether the delirium feature "disorientation" in extubated patients yields diverging findings in comparison to the CAM-ICU and whether the sensitivity of the CAM-ICU may be improved when combined with the feature "disorientation" (CAM-IMC). A total of 86 paired assessments were completed in 50 extubated patients. Delirium was found in 19.8% (N = 17). The CAM-ICU had a sensitivity of 71% (95% confidence interval [CI] 44-90%) and a specificity of 100% (95-100%). Disorientation, if taken as the only delirium feature, had a sensitivity of 77% (50-93%) and a specificity of 93% (89-100%). The CAM-IMC reached a sensitivity of 88% (64-99%) and a specificity of 100% (95-100%). The receiver operating characteristics (ROC) analyses found an area under the curve (AUC) of 0.941 (95%CI 0.851-1.000) for the CAM-IMC, which was the highest compared to the other delirium tests (CAM-ICU, AUC 0.853 [0.720-0.986]; disorientation, AUC 0.868 [0.745-0.991]). This research emphasizes the importance of the feature "disorientation" for delirium assessments in patients able to verbally communicate and explains some controversial delirium ratings in daily practice. The CAM-IMC appears to be an attractive tool for delirium assessment in nonintubated patients and deserves further research.
Collapse
|
10
|
Perman SM, Mikkelsen ME, Goyal M, Ginde A, Bhardwaj A, Drumheller B, Sante SC, Agarwal AK, Gaieski DF. The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients. Sci Rep 2020; 10:20395. [PMID: 33230117 PMCID: PMC7683594 DOI: 10.1038/s41598-020-77438-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
The quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of "poor outcomes:" a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective observational study, we explored the performance of triage qSOFA (tqSOFA), maximum qSOFA, and first initial serum lactate (> 3 mmol/L) at predicting in-hospital mortality and compared these results to those for the initial SIRS criteria obtained in triage. A total of 2859 sepsis cases were included and the in-hospital mortality rate was 14.4%. The sensitivity of tqSOFA ≥ 2 and maximum qSOFA ≥ 2 to predict in-hospital mortality were 33% and 69%, respectively. For comparison, the triage SIRS criteria and the initial lactate > 3 mmol/L had sensitivities of 82% and 65%, respectively. These results demonstrate that in a large ED sepsis database the earliest measurement of end organ impairment, tqSOFA, performed poorly at identifying patients at increased risk of mortality and maximum qSOFA did not significantly outperform initial serum lactate levels.
Collapse
Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Mark E Mikkelsen
- Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Munish Goyal
- Departments of Emergency and Critical Care Medicine, MedSTAR Washington Hospital Centre, Washington, USA
| | - Adit Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Abhishek Bhardwaj
- Division of Critical Care Medicine, Cleveland Clinic Department of Internal Medicine, Cleveland, USA
| | - Byron Drumheller
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, USA
| | - S Cham Sante
- Department of Emergency Medicine, University of New Mexico School of Medicine, Philadelphia, USA
| | - Anish K Agarwal
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - David F Gaieski
- Department of Emergency Medicine, Vice Chair for Resuscitation Services, Director of Emergency Critical Care, Enterprise Physician Lead for Sepsis Care, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street; 300 College Building, Philadelphia, PA, 19107, USA.
| |
Collapse
|
11
|
Almutary A, Althunayyan S, Alenazi K, Alqahtani A, Alotaibi B, Ahmed M, Osman IS, Kakpuri A, Alanazi A, Arafat M, Al-Mutairi A, Bashraheel F, Almazroua F. National Early Warning Score (NEWS) as Prognostic Triage Tool for Septic Patients. Infect Drug Resist 2020; 13:3843-3851. [PMID: 33149629 PMCID: PMC7602891 DOI: 10.2147/idr.s275390] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose We assessed the National Early Warning Score (NEWS) in emergency triage for predicting sepsis-related outcomes. Methods A retrospective chart review of all cases enrolled in the sepsis management protocol for a one-year duration. The protocol utilized the NEWS as a screening tool for sepsis in the triage area. Primary outcomes of interest were hyperlactatemia, admission to ICU and intrahospital mortality. Sensitivity, specificity, and area under the curve (AUC) were calculated for a given NEWS. Results A total of 444 patients were reviewed from July 2018 to June 2019, with a mean age of 58.7 years. A NEWS ≥5 was more than 88% sensitive in predicting hyperlactatemia, ICU admission, and/or mortality. Specificity, on the other hand, was as low as 12%. The AUC for the NEWS was 0.667 for predicting hyperlactatemia and 0.602 for predicting ICU admission or mortality. Conclusion The NEWS was a sensitive screening tool for predicting sepsis-related outcomes. However, it was not specific, and further studies are recommended to assess the integration of other factors to improve specificity.
Collapse
Affiliation(s)
| | - Saqer Althunayyan
- Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Alenazi
- Internal Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Badar Alotaibi
- Emergency Department, Riyadh Care Hospital, Riyadh, Saudi Arabia
| | - Marwa Ahmed
- Pharmaceutical Care Services Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Isam S Osman
- Vascular Surgery Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adil Kakpuri
- Quality Management and Patient Safety Administration, King Saud Medical City, Riyadh, Saudia Arabia
| | - Abdulaziz Alanazi
- Nursing Administration, King Saud Medical City, Riyadh, Saudia Arabia
| | - Mohammed Arafat
- Emergency Medicine Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Fatma Bashraheel
- College of Medicine, Alma'arefa University, Riyadh, Saudi Arabia
| | - Faisal Almazroua
- Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia
| |
Collapse
|